This project proposes to study the extent to which poverty, minority status, and rural location affect the type and volume of obstetrical services received by low-risk pregnant women in Washington state. Research has demonstrated that women who are poor and are members of ethnic minority groups have less access to prenatal care and experience poorer birth outcomes than women who are white and middle class. Yet, little is known about the actual content of care delivered to low-income and minority women during pregnancy. To improve poor birth outcomes, which include low birth weights, prematurity, and high infant mortality rates, we must determine whether these women receive different -- or less -- care than their majority counterparts. The research team will address the following questions: 1.) Is there variation in care among pregnant women based on ethnicity and Medicaid status? Do they receive fewer screening tests and a lower intensity of resources? 2.) Does the proportion of pregnant women in a practice who are receiving Medicaid and/or are members of an ethnic minority group influence the degree to which all women in the practice receive more or less care? 3.) Do Medicaid recipients and women of color in rural settings receive a different spectrum of services than their urban counterparts? Do these women receive less care than privately insured white women in either rural or urban settings? To answer these questions, the research team proposes to further analyze data collected as part of the Content of Obstetrical Care study (AHCPR grant: Practice Variations in Prenatal and Intrapartum Care). The COOC data set consists of a detailed retrospective abstraction of the prenatal and intrapartum charts of low-risk women randomly selected within the practices of a random sample of Washington state obstetrical providers. Care will be compared among approximately 3,000 prognostically equivalent patients. The team will employ statistical methods to ensure that estimates are representative of the Washington state patient population. Actual analysis will use t-tests, chi-square tests, and multiple linear and logistic regression analysis. This study, hopes to determine whether Medicaid status and ethnicity are independently associated with receiving different levels of prenatal and intrapartum care. If so, it hopes to further establish whether differences in care influence birth outcomes. This study should produce a description of the variation in care among women of varying financial, ethnic, and regional backgrounds. Furthermore, it seeks to identify factors such as provider characteristics and practice environment that might explain these variations in care.